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HEM Exam 1 > Antiplatelet and Anticoagulant Drugs > Flashcards

Antiplatelet and Anticoagulant Drugs Flashcards

1
Q

aspirin drug name

A
  • acetyl-salicylic acid (ASA)
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2
Q

aspirin at low doses MOA

A
  • irreversibly acetylates COX1

- inhibits generation of TXA2

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3
Q

higher doses of aspirin MOA

A
  • inhibit COX2
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4
Q

aspirin used for

A
  • primary and secondary prevention of arterial blockages
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5
Q

examples of arterial blockages

A
  • MI
  • stroke
  • PVD
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6
Q

aspirin side effects

A
  • GI bleeding
  • provoke asthma
  • kidney damage
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7
Q

aspirin contraindicated in which population

A
  • children and teenagers with chickenpox or flu symptoms
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8
Q

GI bleeding of aspirin

A
  • inflammation

- peptic ulcer disease

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9
Q

at high doses aspirin can cause

A
  • salicylate toxicity

- tinnitus

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10
Q

warfarin biochemical effect

A
  • vitamin K antagonist
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11
Q

warfarin MOA

A
  • blocks reduction of Vit K

- limits carboxylation of coagulation factors

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12
Q

what stage of vitamin K does warfarin block?

A
  • NEW VITAMIN K
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13
Q

time of effect of warfarin

A
  • not immediate
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14
Q

first three days of warfarin

A
  • brings to hyper coagulable state
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15
Q

how to reverse warfarin hyper coagulable state

A
  • bridging anticoagulant therapies
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16
Q

hyper coagulable state worse in patients with

A
  • protein C deficiency

- vitamin K deficiency

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17
Q

warfarin used for treatment of

A
  • VTE
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18
Q

warfarin used for prevention of

A
  • thrombosis on mechanical heart valves

- embolic strokes in patient with Afib

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19
Q

how do we measure warfarin dosing

A
  • measure INR weekly to start
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20
Q

what do we want the IR to be for warfarin

A
  • between 2-3
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21
Q

drug food interactions of warfarin

A
  • maintain steady amount of vitamin K containing foods
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22
Q

drug-drug interactions of warfarin

A
  • drugs that interfere with CYP enzymes

- antibiotics

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23
Q

monitoring warfarin at therapeutic levels

A
  • follow PT/INR
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24
Q

warfarin at toxic levels has what effect on the aPTT

A
  • prolonged
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25
Q

warfarin effect on PFA-100

A
  • no effect
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26
Q

side effects of warfarin

A
  • alopecia
  • osteoporoesis
  • bleeding
  • warfarin skin necrosis
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27
Q

how does someone get warfarin skin necrosis?

A
  • vitamin K deficient

- protein C deficiency without bridging

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28
Q

warfarin skin necrosis effects the

A
  • microvascular thrombosis

- fatty tissues

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29
Q

warfarin and pregnancy

A
  • warfarin is a teratogen
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30
Q

warfarin and lactating women

A
  • okay for lactating women
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31
Q

warfarin reversal

A
  • vitamin K

- prothrombin complex concentrates (PCC)

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32
Q

PCC composed of

A
  • factor 2, 7, 9, 10
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33
Q

composition of animal derived heparin

A
  • polysaccharide with variable sulfated residues
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34
Q

variation in polysaccharide sequence and length and degree of sulfation in heparin make it

A
  • heterogenous

- each dose different and impacts each individual differently

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35
Q

heparin binds

A
  • antithrombin
36
Q

heparin inactivates

A
  • factor Xa, IXa, XIa
37
Q

full length heparin forms a complex with

A
  • thrombin and antithrombin
38
Q

how long does heparin have to be to inactivate thrombin

A
  • 18 sugars long
39
Q

unfractionated heparin must be given in which form

A
  • IV

- SQ

40
Q

unfractionated heparin must be given in which setting

A
  • the hospital
41
Q

what do you follow in heparin monitoring?

A
  • aPTT

- anti-Xa level

42
Q

heparin effect on TCT

A
  • prolonged TCT
43
Q

heparin effect on PT

A
  • normal as long as it is not a large dose
44
Q

how is the Xa level measured with heparin

A
  • rate of conversation of a substrate into a colored byproduct
  • add patient’s plasma to mix and see if it slows the conversion to a colored solution
  • decrease in rate is the Anti-Xa level
45
Q

heparin side effects

A
  • bleeding
  • osteoporosis with long term use
  • hyperkalemia
  • development of heparin induced thrombocytopenia
46
Q

heparin antidote

A
  • protamine sulfate
47
Q

protamine sulfate MOA

A
  • positively charged

- neutralizes negatively charged heparin

48
Q

low molecular weight heparin compared to unfractionated heparin

A
  • smaller

- about 1/3 the size

49
Q

drug name of LMWH

A
  • enoXaparin
50
Q

enoxaparin given via

A
  • SQ
51
Q

bioavailability of enoxaparin

A
  • immediately bioavailable
52
Q

enoxaparin can be used to

A
  • bridge warfarin
53
Q

enoXaparin MOA

A
  • inactivates Xa
54
Q

why can enoXaparin not inactivate thrombin

A
  • it is too short
55
Q

LMWH effect on PT

A
  • no effect
56
Q

LMWH effect on aPTT

A
  • no effect
57
Q

what do you follow with patients on LMWH

A
  • Anti-Xa levels
58
Q

antidote for LMWH

A
  • no antidote
59
Q

LMWH uses

A
  • VTE treatment and prophylaxis

- VTE associated with cancer

60
Q

treatment of LMWH for VTE

A
  • done at home via SQ

- especially pregnant women

61
Q

LMWH side effects

A
  • bleeding
  • pain at injection site
  • can’t use in dialysis
  • HIT
62
Q

if HIT, what happens with LMWH

A
  • can’t use
63
Q

Fondaparinux complex

A
  • pentasaccharide part of heparin

- don’t use in kidney failure

64
Q

Fondaparinux mechanism

A
  • bind to antithrombin

- inactivate Xa

65
Q

Fondaparinux and HIT

A
  • does not cause HIT

- may worsen HIT

66
Q

Fondaparinux route of administration

A
  • SQ
67
Q

Fondaparinux antidote

A
  • no antidote
68
Q

DOACs

A
  • direct oral anti coagulants
69
Q

Dabigatran MOA

A
  • inactivates thrombin directly
70
Q

Dabigatran used for

A
  • prevention of stroke in Afib patients

- treatment of VTE

71
Q

Dabigatran not used for

A
  • heart valves
72
Q

Dabigatran effect on TT

A
  • prolongs TT because it inactivates thrombin
73
Q

Dabigatran adverse effects

A
  • bleeding
  • GI upset
  • renal clearance
74
Q

Dabigatran mechanism of entry

A
  • oral
75
Q

Dabigatran antidote

A
  • Idarucizumab

- Prax-bind

76
Q

Argatroban mechanism of entry

A
  • IV
77
Q

Argatroban MOA

A
  • direct thrombin inhibitor
78
Q

Argatroban used for patients with

A
  • HIT
79
Q

Argatroban metabolized how

A
  • hepatically
80
Q

Argatroban effect on aPTT

A
  • prolongs
81
Q

Argatroban effect on PT/INR

A
  • prolongs
82
Q

Argatroban effect on TCT

A
  • prolongs
83
Q

Argatroban how to monitor

A
  • use aPTT
84
Q

RivaroXaban, ApiXaban, and EdoXaban MOA

A
  • inactivates Xa
  • binds Xa inhibitor competitively with Xa
  • GLA domain removed to prevent anticoagulant effect
85
Q

RivaroXaban, ApiXaban, and EdoXaban cleared by

A
  • kidney

- chemical degradation

86
Q

DOACs advantages over warfarin

A
  • fewer intracranial bleeds
87
Q

DOACs disadvantages compared to warfarin

A
  • not effects in preventing stroke in patients with mechanical heart valves

HEM Exam 1 (22 decks)

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